Analysis Of Related Factors Influencing PSA Kinetics After Androgen Deprivation Therapy In Metastatic Prostate Cancer

Background:Prostate cancer(prostate cancer,PCa)is a common malignant urinary tumor,with an incidence increasing year by year.80% to 90% of patients at first time diagnosis also had distant metastasis,thus,a contraindication for perform surgical surgery.In that case,the main treatment is the systemic approach.For the patients of hormone-sensitive prostate cancer(HSPC),androgen deprivation therapy(ADT)is one of the most effective treatment.Changes in PSA after ADT treatment in metastatic prostate cancer were considered to be independent prognostic factors for patients.Objective:To investigate the factors influencing the changes of PSA in patients with metastatic prostate cancer during ADT treatment,exploring the independent risk factors of PSA changes,then to guide clinical intervention,to reduce tumor-related complications,to improve the quality of life and prolong tumor progression-free survival.Method:By using the method of retrospective analysis,we analyzed the clinical data of 112 patients with metastatic prostate adenocarcinoma treated by ADT at the Second Affiliated Hospital of Dalian Medical University from June 2008 to June 2016,and the clinical and follow-up data were complete.Risk factors on age,body mass index(BMI),hemoglobin level(Hb),serum alkaline phosphatase(ALP),prostate volume(PV),initial serum prostate-specific antigen(t PSA),clinical stage T,Gleason score,distant metastasis(NM)and so on were measured and ananlyzed by SPSS 20.0statistical software.The patients were divided into PSA compliance group and PSA non-compliance group based on whether the lowest PSA value was less than 0.2ng/ml after ADT treatment.We analyzed the continuous measurement data by `x ± S said,while t test for the differences between groups;We analyzed the count data comparison between groups by non-parametric test.Multivariate logistic regression analysis was used to analyze the statistically significant factors of univariate analysis to evaluate the independent risk factors of PSA non-compliance in metastatic prostate cancer after ADT treatment.The ROC curve was used to analyze the discriminant efficacy of the two successive statistical data factors on the compliance of PSA after ADT treatment.The area under the curve was calculated and the sensitivity and specificity of the PSA standard were predicted at the appropriate threshold.Results: Single factor analysis of hemoglobin levels(Hb)(P = 0.009),alkaline phosphatase(ALP)(P = 0.002),initial serum prostate specific antigen PSA(P <0.001),tumor clinical stage T(P < 0.001),Gleason score(P = 0.008)and distant metastasis(P= 0.002)were significantly affected whether the PSA compliance after the ADT in patients with metastatic prostate cancer(P <0.05);while the age,the body mass index(BMI)and prostate volume(PV)may be no statistically significant effect on the PSA kinetics.Multivariate analysis showed that initial serum prostate specific antigen PSA(OR = 2.30),tumor clinical T stage(OR = 6.23),and distant metastasis(OR = 8.69)were the independent risk factors of PSA non-compliance after ADT in patients with metastatic prostate cancer(P <0.05).Non-parametric tests between groups also suggested statistically significant.That is to say,the higher the initial PSA,the later clinical T stage of the tumor and bone metastases with visceral or distant lymph node metastasis,the less obvious of PSA decreased after the ADT in patients with metastatic prostate cancer.The PSA≥50 ng/ml,tumor clinical T stage≥T3,with bone metastases and visceral metastatic or distant lymph node metastasis in patients of PSA values have not reached below 0.2 ng/ml were significantly more than the control group,the differences were statistically significant(P < 0.05).CONCLUSIONS:1、In patients with metastatic prostate cancer who underwent ADT therapy,the PSA kinetics are affected by a variety of factors,while the primary PSA,clinical stage of T and bone metastases associated with or without visceral or distant lymph node metastasis were the primary values ??for patients with a minimum PSA level less than 0.2 ng/ml as independent risk factors.2、When the t PSA≥50 ng/ml,clinical stage of T≥T3,bone metastasis with visceral or distant lymph node metastasis of the patients with metastatic prostate cancer during ADT treatment should be routinely followed regularly,because of the lower ratio of PSA compliance compared with the control group.Such patients should be routinely followed regularly,once the disease progress,combining with other treatment as soon as possible is necessary.